Inspection on 14/06/07 for Trittiford Road Nursing Home

This inspection was carried out on 14th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Trittiford Road Nursing Home 03/10/06

Trittiford Road Nursing Home 25/05/06

Trittiford Road Nursing Home 07/12/05

Trittiford Road Nursing Home 07/06/05

Trittiford Road Nursing Home 13/12/04

Trittiford Road Nursing Home 11/05/04

Trittiford Road Nursing Home 17/12/03

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Trittiford Road Nursing Home 21-23 Trittiford Road Yardley Wood Birmingham West Midlands B13 0ES Lead Inspector Sarah Bennett Key Unannounced Inspection 14th & 15th June 2007 09:45 Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Trittiford Road Nursing Home Address 21-23 Trittiford Road Yardley Wood Birmingham West Midlands B13 0ES 0121 441 5646 F/P 0121 441 5646 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Accord Housing Association Vacant post Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Care home with nursing, maximum 11 service users, under 65 years of age (11LD). Category is Learning disability. Three existing service users who are over 65 years of age may be accommodated for as long as the home is able to meet their needs. 3rd October 2006 Date of last inspection Brief Description of the Service: The home comprises of two purpose built bungalows. They are home to eleven adults who have a learning disability and additional physical needs. The bungalows were purpose built in 2000, with the accommodated residents in mind. The homes aim to run independently from each other, although some sharing of staff and resources does occur. The providers have discussed separating the two bungalows into separate registrations. The homes have been well designed and adapted to meet the resident’s needs. Facilities include assisted baths, ceiling track hoists in some bedrooms and mobile hoists. All the bedrooms are single occupation. Both homes have a relaxing lounge area and small sun lounge. To the rear of both homes is a pleasant garden with some raised beds to enable wheelchair access. The CSCI inspection report is available in the home for visitors to read if they wish to. The fees as stated in the statement of purpose are £135.53 per week paid to Accord Housing and the care element is funded directly by Social Care & Health. This does not include hairdressing or spending money when going out. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out the unannounced visit over two days. This was the homes key inspection for the year 2007 to 2008. Prior to the fieldwork visit a range of information was gathered to include notifications received from the home, reports from the provider and an AQAA (Annual Quality Assurance Assessment) completed by the Manager. The Manager, staff, the people living in the home and two relatives were spoken with. Conversations with some of the people living in the home were limited due to their complex needs and limited verbal communication. Time was spent observing care practices, interactions and support from staff. This included using the Short Observational Framework for Inspection (SOFI) tool and the outcome of this is recorded throughout this report where it is recorded that it was observed. A tour of the premises took place. Care, staff and health and safety records were looked at. What the service does well: The people living in the home are asked what their likes and dislikes are. Staff make sure that people eat, drink and do the things that they like. Care plans and risk assessments have enough information in them so that staff can support people to meet their needs and be as safe as possible. People living in the home can choose what they eat and drink and are given a diet that keeps them healthy. The people living there were well dressed in good quality clothes that were right for their age and the things they were doing. Staff go out with people to support them to buy their clothes to make sure they are what they want. Each person had a Health Action Plan. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to use. This helps staff to know how to meet the health needs of the people living there. Bedrooms are decorated in the way that each person chooses and they contain many personal items. Relatives said there is nothing wrong with the home. Our daughter is very happy here. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 6 Staff have training so they know how to meet the needs of the people living there. What has improved since the last inspection? What they could do better: Alternative flooring must be considered for use in some rooms in bungalow 21 so that is a nice place for people to live in. Some care plans should include more detail so that staff know how to support the individual and their needs are fully met. Redecoration should be done regularly to make sure that the home is comfortable for the people who live there. All medication should be clearly recorded so that people know their medication is being given safely. The staff meetings should be recorded so that staff that can’t be at the meeting know if the needs of the people living there have changed and how they can support them. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 7 Records of fire drills should show that these happen regularly to make sure that staff and the people living there know what to do if there is a fire. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make a choice about whether or not the home can meet their needs. Their needs are assessed before they move in and they have an opportunity to visit to help them make a choice about whether or not they want to live there. EVIDENCE: The premises are currently owned by Accord and South Birmingham Primary Care Trust (PCT) provides the care. The PCT are withdrawing as the care providers and Accord are taking over this responsibility. The Manager said that a date for this had not yet been confirmed. The statement of purpose of the home and service users guide to the home was dated May 2006. They included the relevant and required information so that it was clear what the home provides. The service users guide included the complaints procedure in picture format making it easier to understand. Since the last inspection one person had moved into the home. Before they moved in a detailed assessment was completed of their needs to ensure that the home is able to meet these and support the person to achieve their goals. The assessment included the person’s family and life history, how they communicate, their likes and dislikes, their behaviours and personality, their Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 10 social, spiritual, recreational, cultural, mobility, eating and drinking and personal hygiene needs, their sexuality, where they like to go on holiday and how they sleep. Before they moved into the home visits were planned so they could get to know the other people living there and the staff and to help make a decision as to whether or not they wanted to live there. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place so that staff have the information they need to support individuals to meet their needs and enable them to make choices about their day- to – day lives. The people living in the home are supported to take risks as part of a risk assessment framework so encouraging their independence whilst maintaining their safety. EVIDENCE: Three records of the people living in the home were sampled. These included an individual care plan. These were detailed and stated how staff are to support the person to meet their needs and achieve their goals. One care plan for supporting the person with their personal hygiene included ‘Please maintain my respect and dignity by closing the door’ to ensure that staff did not just complete the task but were aware of how to be sensitive to the person’s needs. They also stated the person’s likes and dislikes. This helps staff to support the person in the way that they like so achieving a positive outcome for the individual. In one person’s care plan the part ‘How do I celebrate – my favourite way to spend birthday, Christmas and other special times’ was not Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 12 completed. The Manager said that where staff are not sure of this they are not completing it as otherwise it would be their own opinion. As the person does not communicate verbally staff are continuing to observe. Staff had noted recently when it was another person’s birthday that the person did not like it when there was a big gathering of people but was happier when there were people around that she knew. The Manager said this would be monitored again at the next celebration held in the home and if their previous observations are confirmed this will be recorded in the person’s care plan as the way they like to celebrate. Some people living at the home have no verbal communication and staff need to pick up on non-verbal cues and gestures to interpret what the person is communicating. How each person communicates was detailed in their care plan. Care plans cross-referenced to individual’s risk assessments so that staff also knew how to support the person whilst minimising any risks to their health and safety. Care plans and risk assessments were reviewed monthly and updated where there had been any changes to ensure that they were still relevant to the individual. Care plans included supporting the person to make choices about their day-today lives including whether they have a bath or a shower and what they wear. Regular meetings were held with people who live there. Minutes of these showed that people talked about what they want on the menus, where they want to go on holiday, how they want their bedrooms and other rooms in the home decorated, what activities they do, how they celebrate their birthdays and fire safety. In one meeting it was stated that pictures were used to offer a variety of planned meals and choices of drinks available when planning menus. The AQAA stated that they are to explore the use of more picture formats to allow easier understanding and promote involvement of the people living there. Staff were observed offering people drinks, a choice of food, what they wanted to do and where they spent their time throughout the day. One person goes to a day centre in another area of Birmingham. Before they moved in they had transport provided and the Local Authority had agreed to continue to provide this two days a week and this would be reviewed. The Manager said that at the review a couple of months ago it was decided that the transport would be stopped from that day. The person now goes two days a week and staff at the home take her and collect the person as much as possible. Her parents pick her up from there on Tuesday afternoons, which helps staff. The person used to go five days a week and had been going for about seventeen years. They have developed long - standing friendships with other people who go there. When the home did not have enough drivers to take the person during one week the Manager described the affect on the individual ‘terrible’ and she seemed to really miss seeing her friends. A local advocacy group had been involved in this issue before the person moved here. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 13 The Manager had contacted them and said that they are on their waiting list for advocacy input. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements generally ensure that people living in the home experience a meaningful lifestyle. They are offered a healthy and varied diet to ensure their health and well being. EVIDENCE: In bungalow 23 on the first morning of the inspection it was observed that staff spent all the morning interacting positively with the people who live there. One person spent time colouring, looking at holiday photos and choosing a drink when they wanted one. One person spent time in the conservatory, which has been changed into a sensory room. They were looking at the lights and mobiles, listening to music and staff were talking to them. One person had a hand and foot massage, were supported to tidy their bedroom and spent time in the conservatory. One person spent time in the conservatory and in the kitchen while lunch was being prepared. One person spent time in the kitchen while meals and snacks were being prepared. They also spent time in the Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 15 lounge looking at books, magazines and interacting with staff and holding their soft toys. One person was at their parents home where they had spent a couple of days. In the afternoon in bungalow 21 a member of staff was sitting in the lounge with one person for about an hour playing with a soft ball, skittles and a bat There was constant interaction between the person and the member of staff and they were clearly enjoying it as they were laughing and chatting. Daily records sampled for May 2007 showed that people went to daycentres, had a garden party, went to pubs and restaurants for meals, to the hairdressers and went to the local shops and supermarkets. In –house activities included puzzles, games, had a manicure, foot spa, watched TV and DVD’s, art sessions, listened to the radio and spent time in the garden where they sometimes helped to plant flowers. In bungalow 21 one persons records stated In May 2007 “has been accessing the community very little this month, needs to improve but the home continues to run on minimum levels. Although this has been brought up in staff meetings told it’s always been this way this is frustrating to her as her home has become like a prison. Has no personal money at the moment, another factor that adds to lack of community life. Please wherever possible enable the person to access the community.” Similar comments were made in their records in March and April 2007. Their records stated that when they do not go out they become bored and their difficult behaviours increase. Other records for March 2007 showed that the person was not able to go out due to staffing levels. During the inspection and from talking to the Manager it was clear that people had been restricted recently in the activities they were able to do. However, new staff had recently started working at the home and all the people living there now had access to their personal money. The AQAA stated that in the last year they had improved in that each person now accesses the community a minimum of once a week if they wish. In the next 12 months they hope to improve by increasing the benchmark to twice per week and provide more structured in – house activities. The evening before they had held a party to celebrate one of the nurse’s birthday. Staff and the people who lived there said it was a good evening and they enjoyed dancing. Staff said that three people in bungalow 23 are going on holiday to Tenby in September. Holidays are to be planned for other people who want to go away. Staff said that one person had been very unhappy when they had taken her away before and whenever they had taken them on journeys that were longer than local trips. Therefore, they will not be planning to take them on holiday this year but on short local day trips. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 16 Records sampled showed that people are supported to keep in contact with their family and friends through visits from them to the home and visits to them. Records showed and it was observed that people are encouraged to maintain their independence. This included helping to do their laundry and put it away, watching meals being prepared and helped to clean and tidy their bedroom. In bungalow 23 staff were observed sitting with people to eat their lunch and supporting them appropriately to eat where needed. Staff said that it is part of their role to sit and eat with people so modelling good practice at mealtimes. Some people have their food through a PEG (enteral feeding tube), as they are no longer able to swallow safely. The dietician is involved with each of these people and they each have an individual feeding regime to ensure their nutritional needs are met. Fresh fruit and vegetables were available and were included in the menus each day. Menus were varied and were appropriate to the cultural background of the people living there. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are generally satisfactory to ensure that the personal care and health needs are met. The medication is generally well managed to protect the people living there from harm and ensure their well being. EVIDENCE: One person said they had recently gone out with staff and bought new clothes and they were going to get their hair cut and coloured at the weekend. Each person had a detailed moving and handling assessment that stated how staff are to support the person to move whilst ensuring their safety and that of the person being moved. One person’s records sampled showed that they were at risk of developing a pressure sore but there was not a care plan in place to state how staff are to support the person to prevent this from happening. Staff were observed giving a person a hand massage and encouraging them to open and move their hands to improve their flexibility. They were applying Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 18 cream to the person’s hands and massaging it in to ensure their skin was well moisturised to ensure the person was comfortable. Records sampled showed that other health professionals are involved in the care of people living there and staff follow the advice given to ensure the health and well being of individuals. Records showed that people have regular health checks with the dentist, optician and chiropodist where appropriate. Some people who live there have epilepsy and individual epilepsy care pathways are being completed. This is so it is clear how staff are to support the person to ensure their epilepsy is well managed and who else is involved in this. Each person had a Health Action Plan. This is a personal plan about what support a person needs to stay healthy and what healthcare services they need to use. These were produced using pictures making them easier to understand. The AQAA stated and it was observed that Health Action Plans are now linking more fluently with care plans and staff are now using them as a tool to ensure individual’s health needs are met. The Manager had completed a course in PEG (enteral tubes) feeds and she is now training the staff and assessing them as competent to give people their food in this way. So far six members of staff had been assessed as competent to do this. One person’s plan said that they have sensitive skin and they also use continence pads. It did not state what type or size pads the person uses. This is important to ensure wearing the incorrect size or type does not damage their skin. People who live at the home are generally weighed regularly and a record of this is kept. This helps staff to monitor whether the individual has lost or gained a significant amount of weight, which could indicate an underlying health need. The Dietician had recommended that one person in bungalow 21 be weighed every three months unless they obviously gained or lost weight when the frequency should increase. Their records showed that they had not been weighed since January this year. Records of individual’s bowel movements where they had been identified as being at risk of constipation had improved since the last inspection. Where it had been noted that the person had not had a bowel movement staff had ensured that action was taken to ensure the person was not uncomfortable and suffering from constipation. The medication management systems were looked at in bungalow 21. The qualified nurses give the medication to the people living there. However, care staff have training in medicines so that they know what to look for if a person Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 19 should suffer the side effects of the medication or to see if the medication is improving the person’s health and well being. The pharmacist from the Primary Care Trust (PCT) visited in May this year and recommended that some changes were made to the Medication Administration Records (MARS) to ensure that they were clear with changes in individual’s medication. The Manager said that they have requested that the supplying pharmacist do this as the MARS are printed at the pharmacy. However, this had not been done. The Manager said that they are considering using a local pharmacist instead as they feel they would get a better service that would ensure the medicine systems were safe. The PCT pharmacist also stated that care plans needed to be reviewed every six months in line with the medication reviews so that the care plan review can reflect any changes in medication. Some people are prescribed Controlled Drug’s (CD’s). These are stored separately as required and they also need to be counted at the handover of each shift and recorded when given so that there is a running total of the drug. A book was being used to record these but it was not a CD register and it was not clear when the drug had been given or what the running total was. It is recommended that either a CD register be used or a book where daily checks and when the drug is given can easily be recorded and be clear as to how many drugs are being held at the home. This would make it easier to identify if any drugs should go missing or they are being used inappropriately. The medication in the CD cabinet cross-referenced with the amount stated in the CD book. The blister packs containing the medication cross-referenced with the MARS indicating that medication had been given as prescribed. Some people are prescribed PRN (as required) medication. Individual protocols were in place stating when, why and what dosage of this medication should be given to the person. This had been regularly reviewed and updated where there were changes to the person’s medication. Unfortunately one person had died at the beginning of this year. Staff said that they supported the people who wanted to go to her funeral to do so. One person was talking about the person who had died and appeared to be upset. Staff reassured them and acknowledged that they must miss the person as they had lived with them for a number of years. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the views of the people living in the home are listened to and acted on. Arrangements are in place to ensure that the people living there are protected from abuse, neglect and self-harm. EVIDENCE: The service user guide to the home included the complaints procedure. This was produced using pictures so it was easier for people to understand how they make a complaint if they are not happy with the service they receive. The AQAA stated that they hope to improve by devising a user-friendly document for recording complaints. There had been no complaints made to the home or to the CSCI in the last twelve months. For some years the people living in the home have not had access to their bank accounts because the bank would not accept a change of signatory when staff had stopped working at the home. This had meant that although their benefits were being paid into their accounts they could not withdraw their money. They had been loaned some money by the PCT but each person could not spend their money, as they would want to. During one year people could not go on holiday because of this. They had also not been able to pay their rent to Accord and through no fault of their own had accumulated rent arrears. The Manager has worked very hard liaising with legal professionals, the Court of protection, the bank, the PCT and Accord to ensure that people have access to their money. It was pleasing to see at this inspection that all the people Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 21 living there now have access to their bank accounts. The Manager said that each person had paid a minimum lump sum of their rent arrears. She is working with the Commissioners to get the benefits that each person is entitled to, as it has now become clear that over the years several people had not received these. A sum of money had been withdrawn for each person so they could do some personal shopping. One person who had been shopping was very pleased about this and the new clothes they had bought. Receipts were kept of each expenditure and had been put separately in an individual photo album so it was easy to access and clear what each receipt relates to. The Manager provided a breakdown of what benefits each person receives, what their rent arrears are, what they have in their bank account, their weekly income and a breakdown of their benefits, what the shortfall is each week from benefits received to what they have to pay out and what each person can pay in rent arrears. Their rent arrears ranged from £3,763 to £19,208 in January 2007 with the majority of people being about £14,000 in arrears. Bank statements showed that individual’s benefits had been paid into their account regularly. Recently money had been transferred from their accounts to Accord to pay rent arrears. Prior to that people had not been able to access their accounts since the beginning of 2005. The work that the Manager has completed will improve the quality of the lives of the people who live there and ensure that their rights are respected. The AQAA stated that they plan to ensure that each person receives their correct benefits and their entitlement to Registered Nursing Contribution to Care (RNCC) payments. The Manager said she is going to have intensive training on the benefits system to help her to do this. The Manager said that most staff had now completed training in adult protection and the prevention of abuse. Staff who had recently started working at the home will do this as part of their Learning Disability Award Framework (LADF) training. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are generally sufficient to ensure that people live in a homely, comfortable and safe environment that meets their needs. EVIDENCE: The kitchen cupboards were in good condition as were the tables and chairs. In bungalow 23 there were some small holes in the kitchen flooring where the previous cupboards were removed and the flooring was stained. There were some bashes from chairs and marks on the kitchen walls. The Manager said that it is planned that both kitchens are to be redecorated. In bungalow 23 the conservatory had been changed into a sensory room. It was observed that this was used more by the people who live there and they seemed to benefit more from spending time in the relaxed environment that had been created there. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 23 Bedrooms had been personalised to individual tastes, ages, cultural backgrounds and interests. One person had brought their own furniture when they moved in so they felt ‘at home.’ The shower rooms and bathrooms have adapted equipment to help people to be safe and as independent as possible when using the bath or the shower. The weighing hoist had been repaired so that people can now be weighed at home instead of going to the weighing clinic where they may have to queue or it may be difficult to get there often depending on transport available. Since the last inspection one person in bungalow 21 had a ceiling track hoist fitted in their bedroom and the shower room that they use so they can be supported and moved around by staff safely. The water does not drain away easily from the shower room in bungalow 21 causing this to become flooded and unsafe. Staff said that the flooring in this room is going to be dug up at the end of the month and re - laid to solve this problem. The carpets in the lounge, hall and some of the bedrooms in bungalow 21 were very stained. The Manager said they had arranged for all carpets to be cleaned the following week even though they had last been cleaned in February this year. An alternative floor covering needs to be considered as it is clear that this is not suitable for the people who live there. A lot of work had been done on making the gardens more pleasant for people to spend time in. Some people who live there had been involved in doing this and planting the flowers. There were several pots, raised flowerbeds and grassed areas. Solar lighting had been provided along the path in bungalow 23 making the garden more attractive as well as secure. Both of the bungalows were clean and there were no offensive odours so it was pleasant for the people who live there to spend time in. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are generally sufficient to ensure that an effective, competent and supervised staff team who can meet individual’s needs support them. The people living there are protected by the home’s recruitment practices. EVIDENCE: The AQAA stated that out of twenty three care staff twenty have NVQ level 2 or above and three are working towards completing this. This exceeds this standard that at least 50 of staff have achieved this so ensuring that care staff have the skills and knowledge to meet the needs of the people living there. Rotas showed and it was observed over the two days that minimum staffing levels are met. Regular bank staff are used to cover maternity leave, holidays and sickness to ensure that staff that work there know the people who live there well. There were two student nurses on placement at the home and they work in addition to the staff on the rota. There is a qualified nurse on duty during the day and night in each bungalow and they are supported by care staff. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 25 Minutes of staff meetings showed that there had been three meetings in the last year. The manager said they have also had other meetings but the minutes could not be found. There should be at least six staff meetings held each year so that all staff know of any changes in the needs of the people who live there and how they are to meet these. Minutes should be available for staff who were absent so that they have access to the information. The Manager said that three members of staff had transferred to other homes, which had recently meant that there were days when the home fell below the minimum staffing levels and it made it difficult for the people living there to access the community. However, two new members of staff had recently started working in bungalow 21. There were no staff vacancies but the Manager said that they have put in a bid to the Commissioners for another member of staff to ensure that the people living there are well supported. One member of staff was on maternity leave and two members of staff were off sick short-term. Staff records showed that staff had completed an induction when they first started working at the home. The two staff recently recruited in bungalow 21 were on duty but were working in addition to the rota as part of their induction. The Manager was doing training in acting as an Appointee for the people who live there. The Manager said that the majority of staff had successfully completed the Safe Handling of Medicines course, adult protection and the prevention of abuse, food hygiene, infection control, health and safety and dementia training. Staff records sampled included the required recruitment records. These included evidence that a satisfactory Criminal Records Bureau (CRB) check had been undertaken to ensure that ‘suitable’ people are employed to work with the people who live there. There are two nuns from a local convent who visit the home on a voluntary basis often to visit one person and give them Holy Communion but they also spend time with the other people who live there. They have had satisfactory CRB checks returned and the Manager had also arranged for them to go on moving and handling training on the second day of the inspection. It is good that the Manager had arranged this so that people who volunteer are able to ensure the safety of the people who live there. Records of individual formal supervision sessions between the member of staff and their manager showed that these were not regular during 2006 but this was improving this year. Records included discussions around the training and development needs of the individual and recorded that all the mandatory training was up to date or had been booked for the member of staff to attend. The AQAA stated in the last year there is now a designated training coordinator who is responsible for all ensuring that all staff training is booked and kept up to date. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the people living there benefit from a well run home and can be confident that their views underpin all self-monitoring, review and development by the home. Arrangements ensure that the health, safety and welfare of the people living there is promoted and protected so ensuring their safety and well being. EVIDENCE: Recently a decision had been made that there would be one Registered Manager for both the bungalows not a separate manager in each as had recently been decided. However, the findings of this inspection have found that this arrangement is working well and the Manager is ensuring that the people who live there benefit from a well run home. Their application for Registered Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 27 Manager had recently been forwarded to the CSCI. The Manager is a Registered Learning Disability Nurse and has several years of managing care homes for people who have a learning disability. A representative from Accord visit the home monthly and writes a report of their visit as required under Regulation 26 to ensure that the home is meeting the requirements of the Care Homes Regulations 2001 and providing a good service for the people who live there. A representative from the Trust completes a monthly audit of the home also. A representative from the Trust completed a quality assurance audit. These have all included the views of staff and the people who live there where possible. Fire records showed that staff had training in fire safety. The Trust Fire Officer had completed the fire risk assessment to ensure all steps are taken to minimise the risk of there being a fire. Staff had regularly tested the fire equipment to make sure it is working. Fire records showed that the last fire drill was in November 2006. The manager said there was a fire drill in April this year but they had forgotten to record it. An engineer had regularly serviced the fire equipment. Staff test the water temperatures weekly to make sure they are not too hot or cold. In bungalow 23 it was recorded in June that the water pressure was very low in the bathrooms the temperature could not be read. This was reported to Accord and the pressure was adjusted. Water temperature records showed that these are within the safe temperature range of 43 degrees centigrade. The Manager said that the shower room temperature has been too cool in bungalow 21 and when they re – do the flooring the contractors will also adjust the valves. An engineer regularly services the hoists and adapted baths to make sure these are safe and working properly. An electrician tested the portable electrical appliances in April 2007 to make sure they are safe to use. Staff test the fridge and freezer temperatures daily to make sure they are within the limits for safe food storage. Records showed that they were within the safe limits. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 3 3 X 3 X X 3 X Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23 (2) (b, d) Requirement Alternative floor covering must be considered where appropriate that meets the needs of the people who live there. This will ensure that the home is homely and comfortable. Timescale for action 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA19 Good Practice Recommendations Where it has been identified that a person is at risk of developing a pressure sore this should be included in their care plan so that staff know how to support them to minimise this risk. Care plans should detail the size and type of the incontinence pads that a person uses where appropriate to ensure that the person’s skin is not damaged and they are comfortable. Where a person is at significant risk of losing or gaining weight they should be weighed regularly and this be recorded to ensure their health and well being. Controlled Drugs should be recorded so it is clear when they have been given to people to ensure they are used DS0000024900.V344756.R01.S.doc Version 5.2 Page 30 2. YA19 3. 4. YA19 YA20 Trittiford Road Nursing Home 5. 6. 7. YA24 YA33 YA42 safely. Redecoration should be regularly completed to ensure the home is comfortable and homely for the people who live there. Minutes of all staff meetings should be available so that all staff are informed of any changes to the needs of the people living there and how they are to meet them. Fire drills should be recorded so it is clear that the health and welfare of the people living there is safeguarded. Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Trittiford Road Nursing Home DS0000024900.V344756.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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